Minimally invasive prostate surgery as a treatment option for older men

This study examined the safety and effects of minimally invasive prostate surgery in older men with localized (confined) prostate cancer. Researchers reported similar outcomes of minimally invasive prostate surgery in older patients and in younger patients.

Prostate surgery is a first-line treatment for localized (confined) prostate cancer. It has been less frequently prescribed for older men (aged 70 years or older) or men with a life expectancy of less than 10 years. In recent years, however, the role of prostate surgery as a treatment for older men has expanded. This is due to increased life expectancies as well as advances in surgical techniques.

Minimally invasive prostate surgery (MIPS) is associated with fewer complications compared to open surgery. It involves a few keyhole incisions to remove the prostate instead of one larger incision in the abdomen. More studies are needed to examine the safety and effects of minimally invasive prostate surgery in older men.

The aim of this study was to compare the effects of open and minimally invasive prostate surgery across age groups.

The records of 12,092 men undergoing surgery for localized prostate cancer were analyzed. 48% of men were treated with MIPS. 52% of men were treated with open surgery. Men were divided into two age groups: 70 years or older (55.1% of men) and between 66 and 69 years (44.9% of men).

Overall, MIPS was associated with fewer complications than open surgery in both age groups. Open surgery significantly increased the risk of needing a blood transfusions during surgery. Complications after surgery related to respiration or digestion were also more likely with open surgery. There was less damage to neighboring tissue with MIPS.

Men treated with MIPS were less likely to need additional cancer treatment. Younger men undergoing MIPS had a 33% lower risk of needing additional treatment. Older men undergoing MIPS had a 14% lower risk of needing additional treatment.

Erectile dysfunction was more common after MIPS (56.9%) compared to open surgery (42.2%). Older men undergoing MIPS had 10% lower rates of erectile dysfunction compared to younger men. Urinary incontinence was also more frequently reported following MIPS (53.9%) compared to open surgery (43.2%). The rate of urinary incontinence increased by 47% in older men and by 37% in younger men with MIPS.

Older men were 60% more likely than younger men to have a blood transfusion during MIPS. The risk of damage to neighboring tissue was 22% higher for older men. The average hospital stay was 1.74 days for younger men and 1.9 days for older men. The risk of complications related to the digestive system was 30% higher for older men compared to younger men.  

Having more additional medical conditions increased the likelihood of a blood transfusion and complications related to the heart or respiration. Men with high-risk prostate cancer were also twice as likely to have respiratory complications compared to low-risk disease. The need for additional cancer treatment increased 3-fold for men with intermediate-risk disease and 13-fold for men with high-risk disease.

Researchers concluded that minimally invasive prostate surgery is a successful prostate cancer treatment for older patients.